Lost in knowledge translation? 5 tips to bring research evidence into implementation

To impact the health and well-being of older adults, real-world change has to take place: at the level of individual behaviour, and through to the levels of practice, communities and beyond. Implementation research in health and healthcare can help catalyse this change by going beyond knowledge creation to translate evidence into tangible shifts in policy and practice. However, researchers often encounter practical hurdles in the knowledge translation process.

At a recent seminar with GERI researchers, knowledge translation expert and GERI Adjunct Scientist, Dr Sharon E. Straus, outlined 5 best practices for researchers to enhance the adoption of research evidence into routine care and practice.

Dr Straus is the Director of the Knowledge Translation Program and Executive Vice-President, Clinical Programs and Chief Medical Officer at Unity Health Toronto. She is a Professor in the ​​Department of Medicine, University of Toronto and holds a Tier 1 Canada Research Chair in Knowledge Translation and Quality of Care.

1. Apply an “implementation research sensibility" to dissemination efforts

“It is rare for most projects to immediately go on to implementation," observed Dr Straus. “Usually our first step is around dissemination, and really thinking about that." This means understanding how each target audience group receives and uses research evidence, and tailoring key messages and translation strategies for each audience type. “It is about thinking what the barriers and facilitators are," said Dr Straus.

One such facilitator is active dissemination approaches to encourage the use of evidence in practice. “For example, we could think about working with clinicians to understand what they would like to know from your research, and working with them on preparing key messages," Dr Straus said.  From there, more interactive strategies could be employed, such as educational meetings to help clinicians use a guideline in their practice.

Another facilitator is translating complex research into meaningful messages. As Dr Straus puts it, “We have got all this data (…) How do we, in a single picture, explain this to a clinician?" In an example, her team turned complex study findings into a rank-heat graph (akin to a heat map), with different colour codes and circles to convey an array of health outcomes and the interventions studied. This way, clinicians could identify the most effective interventions at-a-glance.

2. Get stakeholders on board with simple nudging strategies.

Getting buy-in from stakeholders for scaling up an intervention can be challenging. Making the effort to understand why they are not supportive could help in addressing that challenge.

“If they do not have the time, find ways to align with their time, in order to make it (the intervention) easier to implement. For instance, maybe there are things that can be taken away to make the implementation of this process or intervention easier," suggested Dr Straus. To encourage stakeholders to take the leap, “champions" could be identified who can model the desired behaviour within their context.

To nudge stakeholders towards evidence-informed intervention design, Dr Straus's tip would be to illustrate with examples, such as where interventions implemented without evidence resulted in resource waste or even outright harm to care recipients.

3. When working with policymakers, engage them closely and manage their expectations.

Policymakers want research that they can use to inform their decisions. A challenge that researchers often face when producing such time-sensitive research for policymakers is that additional funding may not be available and researchers have to juggle multiple other projects.

Drawing from her team's experience, Dr Straus shared, “If we are doing work with policymakers, we stay very closely engaged with them and give them updates regularly, not just at the beginning and when we are almost done. It is about making sure that we keep that communication going."

It is also important to outline for the policymaker what the research team can or cannot do based on resource or funding availability. By “understanding from the beginning what their (policymakers') timelines are and helping them understanding what our (researchers') timelines are", policymakers' expectations can be managed, Dr Straus said.

4. Ask questions to identify the right framework or implementation strategy to use.

Researchers are often concerned about settling on the single best-fit theory or framework to map implementation barriers and facilitators. However, Dr Straus cautions that there is no such “perfect" nor single framework. Instead, part of what this selection process entails is asking yourself what the purpose and goal of your project is before considering available options.

Similarly, when selecting implementation strategies for a particular intervention, researchers should consider key questions grounded in the project's context. Dr Straus outlined some examples, such as asking whether the potential implementation strategy is compatible for the intervention's setting, or whether it is feasible, equitable, affordable, effective and cost-effective.

Questions around sustainability can also inform the eventual implementation strategy. “It is important to be working with partners in different organisations to think about whether this is going to be sustainable, or what might happen when funding runs out," said Dr Straus, adding that possible risk to outcomes and future engagement are also important to consider.

5. Support site-implementation teams by being specific and detailed.

When supporting implementation teams in operationalising chosen interventions, leave no room for guesses. “Name it (the implementation strategy), define it, specify what it is going to be," Dr Straus emphasised. These include spelling out timelines, what specific supports will be needed, and what implementation outcomes are anticipated to be affected.

This approach becomes especially valuable when working on multi-site interventions. “If you have multiple sites for your implementation strategies, what we (Dr Straus's study team) did was that we gave each organisation a different implementation plan that was tailored to the barriers and facilitators of their setting."

By supporting site teams with “a recipe that they could follow", researchers can give implementers a tangible toolkit and approach that they can and are more likely to use—for both the project at hand, and for future initiatives.